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NADE Petitions for Elimination of the Five Month Waiting Period

Position Paper, submitted July 19, 1999

I have to wait five months to get my first check?!? I could be dead by then! This is a sad but often true statement from Title II disability claimants who learn that they must wait five full calendar months before they can begin receiving disability benefits. The fact that this waiting period is prescribed by federal law does not offer any comfort to these individuals, nor does it diminish the perception that the Social Security Administration fails to provide assistance to these claimants and their families in their time of desperate need. Furthermore, once these benefits do begin, they are not retroactive for the waiting period. Consequently, for the first five months after the onset of disability, the majority of claimants filing under Title II of the Social Security Act do not receive any financial compensation. Also, because the five month waiting period does not begin until the first day of the month following onset, the waiting period may sometimes be closer to six months. For most Title II claimants, this waiting period imposes a severe financial hardship since the costs of medical care, added to their day to day living expenses, can quickly deplete these claimants and their families of their savings.

For the past several months, members of the National Association of Disability Examiners (NADE) have examined the pros and cons of eliminating the waiting period.

NADE is a professional association whose membership includes disability examiners, physicians, psychologists, attorneys, federal and state administrators, disability hearing officers and support staff personnel. We believe that this diversity of our membership, as well as our hands on experience and familiarity with SSA and DDS operations, enables our association to offer a perspective that is both unique and informed. The Social Security program began in 1935 as the bold vision of President Franklin D. Roosevelt. President Roosevelt declared that the social welfare needs of this country demand, “bold, persistent experimentation.” President Roosevelt further challenged the country to continue to make future improvements for Social Security, asserting that, “…we should be constantly seeking to perfect and strengthen it in the light of our accumulating experience and growing appreciation of social needs.”

Since its inception in 1935, Congress and SSA have continually responded to these needs, adding the disability program and later adding the Medicaid program. The addition of these two programs, which met the needs of so many people, is to be commended. The disability program was added in 1956 as a major effort to provide for the financial well being of American workers who became disabled before reaching retirement age. While cash benefits were not included in the initial implementation of the disability program, they were soon added. A waiting period of six months was prescribed in the law that created the disability program. The law initially defined disability as, “expected to be of long continued and indefinite duration or result in death.” In 1967, the definition of disability was amended and “long continued and indefinite” was changed to “not less than 12 months.” The length of the waiting period remained unchanged.

Responding to political pressures, Congress did act in the 1970s to reduce the waiting period from six to five months. The members of NADE commended this action. Now, we believe that it is time to revisit this issue.

The membership of NADE strongly believes that the ongoing effort by Congress and SSA to continuously examine the needs of the American people and to provide for those needs through Social Security is to be commended. Today, the Social Security program is the cornerstone of American social and, in many respects, economic policy. In its current strategic plan, the Social Security Administration has declared its mission to be:

“To promote the economic security of the nation’s people through compassionate and vigilant leadership in shaping and managing America’s social security programs.”

In light of this mission statement, the members of NADE ask:

1. How does requiring the disabled worker to wait five months before beginning to receive benefits promote economic security for the nation’s people?

2. How compassionate is a program if the disabled worker must wait five months before beginning to receive benefits?

3. Is now not the appropriate time for vigilant leadership to shape and manage the disability program so that the disabled worker can receive benefits at the earliest possible moment?

In addition to the economic hardship imposed by the five month waiting period, NADE members recognize – and experience – the emotional impact when Title II claims must be closed as “No Decision” (technical denials) because the claimant died during the waiting period. In these situations, the DDS disability examiner simply closes the claim file and returns it to the local Social Security office. Unless there are surviving spouses or children who are eligible to receive death benefits, no further action is taken on behalf of these disabled workers who die prior to the expiration of the waiting period. In other situations where the claimant is suffering from a terminal illness with a relatively short life expectancy, allowance decisions are made by disability examiners with full knowledge that the claimant’s medical condition will either result in death prior to the expiration of the waiting period, or shortly thereafter. In many of these situations, the claimant’s death leaves the family with tremendous medical bills and other debts which add to the financial burden created by the wage earner being out of work due to the disabling condition.

While many Title II claimants continue to receive health insurance coverage provided by their employer, many disabled workers do not have access to adequate health insurance or, because of insufficient funds, are unable to continue to pay their monthly premiums after becoming disabled. Even for claimants that have health insurance coverage and have sufficient funds to maintain at least a moderate standard of living, the loss of their income, even for a few short months, can often create severe financial pressures. In situations where the spouse of the disabled worker also works and could conceivably continue to supply at least a portion of the family’s income, this is often interrupted by the necessity for the spouse to stay home and provide assistance to the disabled worker. Financial pressures created by the loss of the disabled worker’s income often force these claimants and their families to make life altering changes to the family’s lifestyle. The members of NADE strongly believe that claimants and their families, who are forced to deal with the onset of disability, should not then be forced to deal with the onset of financial hardship made necessary by having to wait five months to receive cash benefits.

Consequently, the members of the National Association of Disability Examiners would like to go on record as asking the Social Security Administration and the Congress to revise the statute and eliminate the waiting period for Title II claimants. In our opinion, this would be an extremely humane gesture for these disabled workers and their families. It would also fulfill the mission statement of the Social Security Administration “To promote the economic security of the nation’s people through compassionate and vigilant leadership in shaping and managing America’s social security programs.” It would also reflect the vision of President Roosevelt to constantly seek to perfect and strengthen Social Security in the light of our accumulating experience and growing appreciation of social needs.

NADE has projected the current maximum cost of eliminating the waiting period. In FY 1998, the average monthly benefit paid to Title II disabled workers was $733.00. Thus, the elimination of the five month waiting period would provide an average direct cash benefit of $3665.00 for each disabled worker. In FY 1998, a total of 608,131 Title II disability claims were allowed. Therefore, if the five month waiting period had been eliminated in FY 1998, an additional $2,228,800,115 would have been paid to Title II disabled workers. However, we hasten to add that, since SSA would have realized some reduction in their administrative costs, the $2.2 billion price tag would be an overestimate of total costs. Furthermore, the projected $2.2 billion cost would be reduced even further by subtracting the Title XVI benefits that were paid during the five month waiting period to the small percentage of Title II claimants who had filed concurrent disability claims and subsequently collected SSI benefits during the waiting period. At present, NADE is not able to project the total impact on our $2.2 billion cost estimate that these projected savings in administrative and program costs would have. We do believe, however, that the total cost of eliminating the waiting period will be significantly less than $2 billion.

While Congress and the Social Security Administration are concerned with SSA solvency issues, the additional expenditure of perhaps $2 billion may appear to be beyond serious consideration. However, there are many options available to obtain the necessary funds. Of course, the most important reason to give serious consideration to the issue is that, for those 608,131 disabled workers who were allowed last year, “it is the right thing to do.”

We recognize that many of the options available to raise the necessary funds to support the elimination of the waiting period have political and other consequences. We do not choose to debate the advantages and disadvantages of any of these proposals. However, we do want to mention a few options as evidence of the fact that these options do exist and that the necessary funds can be obtained.

SSA is currently undertaking major revisions in the disability program. These revisions are not likely to produce any cost savings in the current budget for the disability program. In fact, NADE has gone on record as suggesting that the projected costs of these revisions are an actual underestimate of what the real costs will eventually be. However, we are interested in working with SSA to determine if any real cost savings can be produced to cover even a portion of the projected costs of eliminating the waiting period.

The increased success of SSA’s Office of Inspector General in identifying fraud and recovering monies spent by SSA that were fraudulently obtained offer another source for funds that could cover a portion of the projected costs of eliminating the waiting period.

The most likely source of the necessary funds is the recent focus by Congress and SSA on return to work issues that should reduce the future demand on the continuation of benefit payments. As these programs are developed and prove successful in returning more beneficiaries to the workforce, fewer beneficiaries and their dependents will receive ongoing benefits. If 50,000 beneficiaries can be returned to the workforce each year, this would produce savings in program costs of nearly $440 million per year (approximately 20% of the funds needed to cover the costs of eliminating the waiting period). Also, this figure does not include the additional benefit payments that are paid to the disabled worker’s dependents.

The recently renewed emphasis on continuing disability review claims (CDRs) can be expected to produce further savings in the disability program that could cover a portion of the costs of eliminating the waiting period. NADE emphasizes that the CDR process is a separate function and should not be utilized solely to pay increased benefits to other workers. However, it is a part of the disability program that has, at least in the past, not received the attention that it should.

Another option would be to revise the current Medical Improvement Review Standard for the continuing disability review process. The current statutes require the DDSs to show that a beneficiary’s disabling condition has medically improved before benefits can be ceased. While this certainly appears to be a reasonable requirement, it does prevent the DDSs from ceasing benefits for those beneficiaries who were awarded benefits in the past based on determinations that now appear questionable in view of modern medical practice and technology. Many of these beneficiaries could reasonably be expected to return to the workforce. NADE would be willing to work with SSA and the Congress to develop a more practical standard for continuing disability review cases.

It is probable that a variety of methods would need to be employed to produce sufficient revenue necessary to pay for the costs of eliminating the waiting period. However, the members of NADE firmly believe that the necessary funds can be found and we offer our assistance in the process of searching for these funds.

The waiting period serves only as a public relations disaster for the Social Security Administration. SSA is also charged with the adjudication of disability claims filed under Title XVI of the Social Security Act. Claims allowed under this provision of the law do not have any waiting period and benefits are paid from the date of application. This places SSA in a dubious situation. SSA finds itself operating two disability claims processes in which the same definition of disability applies to both, the same medical listings and adjudicative procedures apply to both, but where the claimant who has contributed to the nation’s workforce is actually penalized for having done so.

Our proposal to eliminate the five month waiting period could be accomplished in incremental steps, beginning with gradual reductions in the waiting period. A scale can be developed whereby the five month waiting period will be reduced to four months in fiscal year 2002, then to three months in fiscal year 2003, and so on. Each reduction in the waiting period would be accompanied by a careful analysis to insure that sufficient revenue is available to pay the costs of the reduction. Otherwise, the reduction process could be put on hold for a year or two until the needed revenue can be produced.

Legislation has been introduced in the past that would eliminate the waiting period for individuals who were determined to have a terminal illness. NADE has considered that option. However, further discussions made it clear that such a proposal would have serious future consequences, none of which would produce positive results or cast the Social Security Administration in a positive light. For example, the question of who would make the determination of whether or not a claimant is terminally ill would create unnecessary debate and prolong the effort to pay disabled workers as quickly as possible. Also, would claimants be allowed to appeal a finding that they were not terminally ill? Negative headlines in the media could be expected, especially in those situations where claimants subsequently died while the determination that their medical condition was not terminal was being appealed. In addition, litigation from certain special interest groups and other claimants would be expected. Such litigation would argue such constitutional questions as to whether it was lawful to eliminate the waiting period for only a selected group of beneficiaries.

It became clear, during the course of our discussion of this proposal, that this attempt to narrow the focus and costs of this proposal would create additional problems that would likely jeopardize the chances of success. Therefore, NADE abandoned the idea to narrow the focus and costs of our request.

The Social Security Administration is currently preparing major revisions in the disability program. These revisions are designed to make the program more customer friendly and will emphasize more claimant direct contact with the decision-maker. The proposal to eliminate or reduce the five month waiting period is certainly a revision whose time has come. In the context of these many other changes and revisions that are being made to bring the disability claims process into the 21st century, what better time than the present to proceed with the very customer friendly step of eliminating the waiting period? Now is the time for vigilant leadership to recognize the need for compassion and fairness in the Social Security programs. We ask for your help in promoting a change to eliminate the five month waiting period. Together, we can stand up for fairness and compassion for those most vulnerable members of our society in their time of greatest need.

Questions concerning NADE’s position on this matter may be directed to: